Treatment of refractory and severe hypothyroidism with sublingual levothyroxine in liquid formulation

Peirce, Carmela; Ippolito, Serena; Lanas, Alejandra; Pesce, Marcella; Pontieri, Gilda; Arpaia, Debora; Sarnelli, Giovanni; Biondi, Bernadette

doi:10.1007/s12020-017-1367-5

Cited by 14 publications

(12 citation statements)

References 19 publications

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“…Once excluded duplicates articles, the papers initially included were 13. Abstracts of these articles were screened and 7 ( 21 , 26 – 31 ) were excluded according to the abovementioned criteria [4 reported small series ( 26 , 28 – 30 ), 1 included patients showing the effect of switching T4 treatment in patients, which had already reached normal TSH with traditional tablet formulation ( 27 ), one described the use of a non-pharmaceutically produced liquid preparation ( 31 ), one enrolled only differentiated thyroid carcinoma patients ( 21 )]. Finally, the systematic review included six original articles ( 32 – 37 ).…”

Section: Resultsmentioning

confidence: 99%

Levothyroxine Therapy: Changes of TSH Levels by Switching Patients from Tablet to Liquid Formulation. A Systematic Review and Meta-Analysis

et al. 2018

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BackgroundIn the last years, levothyroxine (LT4) has been commercialized also in liquid formulation, which is less sensitive to the factors known to reduce the absorption of tablet LT4. To date, there is no robust information that liquid LT4 can improve pharmacologic thyroid homeostasis of patients with reduced efficacy of tablet LT4. This analysis aimed at achieving solid evidence that switching thyroxine treatment from tablet to liquid preparation improves patients’ TSH levels.MethodsThe search was performed in PubMed/MEDLINE and Scopus database based on the terms “thyroid,” “levothyroxine,” and “liquid,” and updated until September 25, 2017. Studies were included only if they described patients with suboptimal TSH on tablet LT4, subsequently switched to liquid LT4.ResultsThe literature search retrieved 462 articles and six were finally included. The pooled mean difference of TSH value between tablet and liquid LT4 was 4.23 mIU/L (95% CI from 3.69 to 4.77). Mild heterogeneity was found (I2 60%). Overall mean difference of TSH was significant (p < 0.0001).ConclusionThe present meta-analysis showed that patients with suboptimal TSH on tablet LT4 can have a significantly improved TSH by switching to liquid LT4 formulation at unchanged dose.

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Section: Resultsmentioning

confidence: 99%

Levothyroxine Therapy: Changes of TSH Levels by Switching Patients from Tablet to Liquid Formulation. A Systematic Review and Meta-Analysis

et al. 2018

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“…Additionally, through the LEfSe method the authors were able to show many differences in these 27 genera composition between the patients and the healthy control, differences that were also correlated with clinical manifestation and laboratory data (72). Both in HT and GD the first therapy strategy is represented by the recovery of euthyroidism, in the first case by hormone replacement therapy, in the second case trough specific antithyroid drugs (73). The achievement of therapeutic goal may significantly differ, in both conditions, from patients to patients.…”

Section: Microbiome and Thyroid Autoimmune Diseasesmentioning

confidence: 93%

The Human Microbiota in Endocrinology: Implications for Pathophysiology, Treatment, and Prognosis in Thyroid Diseases

et al. 2020

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The human microbiota is an integral component in the maintenance of health and of the immune system. Microbiome-wide association studies have found numerous diseases associated to dysbiosis. Studies are needed to move beyond correlations and begin to address causation. Autoimmune thyroid diseases (ATD) are one of the most common organ-specific autoimmune disorders with an increasing prevalence, higher than 5% worldwide. Most frequent manifestations of ATD are Hashimoto’s thyroiditis and Graves’ disease. The exact etiology of ATD remains unknown. Until now it is not clear whether bacterial infections can trigger ATD or modulate the efficacy of treatment and prognosis. The aim of our review is to characterize the microbiota and in ATD and to evaluate the impact of dysbiosis on treatment and prognosis. Moreover, variation of gut microbiome has been associated with thyroid cancer and benign nodules. Here we will characterize the microbioma in benign thyroid nodules, and papillary thyroid cancer to evaluate their implications in the pathophysiology and progression.

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“…A study by Peirce et al (33) in 2018 of patients who underwent total thyroidectomy with severe hypothyroidism reported that euthyroidism was progressively restored after sublingual administration of liquid LT4, making this formulation a valid alternative method for acute treatment of severe hypothyroidism.…”

Section: Liquid and Soft Gel Formulationsmentioning

confidence: 99%

“…The prevalence of patients in the hypothyroid range was significantly higher in the LT4 tablet group (13.5%) vs. the liquid LT4 group (1.8%) Peirce et al(33) 3Liquid vs. tablet LT4 in patients with severe hypothyroidism after total thyroidectomy All patients (100%) were restored to euthyroidism after switching from LT4 tablets to LT4 liquid form…”

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confidence: 96%

Levothyroxine Therapy in Thyrodectomized Patients

2021

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Administration of the optimal dose of levothyroxine (LT4) is crucial to restore euthyroidism after total thyroidectomy. An insufficient or excessive dosage may result in hypothyroidism or thyrotoxicosis, either one associated with a number of symptoms/complications. Most literature regarding the LT4 dosage deals with the treatment of primary hypothyroidism, whereas a limited number of studies handle the issue of thyroxin replacement after total thyroidectomy. A literature review was performed focusing on all papers dealing with this topic within the last 15 years. Papers that reported a scheme to calculate the proper LT4 dose were collected and compared to set up a review exploring limits and drawbacks of LT4 replacement therapy in the wide population of patients who had undergone thyroidectomy. Most of the methods for monitoring and adjusting thyroid hormone replacement after thyroidectomy for benign disease use LT4 at an empirical dose of approximately 1.6 μg/kg, with subsequent changes according to thyroid function test results and assessments of the patient’s symptoms. Approximately 75% of patients require a dose adjustment, suggesting that factors other than body weight play a role in the determination of the proper LT4 dose. Hence, several schemes are reported in the literature for the proper initial dose of LT4. An inadequate level of thyroid hormone levels in these patients can be due to several factors. The most common ones that lead to the necessity of LT4 dose adjustments include lack of compliance, changes in LT4 formulation, dosage errors, increased serum levels of T4-binding globulin, body mass changes, and dietary habits. Moreover, concomitant ingestion of calcium supplements, ferrous sulfate, proton-pump inhibitors, bile acid sequestrants, and sucralfate might influence LT4 absorption and/or metabolism. Furthermore, some gastrointestinal conditions and their treatments can contribute to suboptimal LT4 performance by altering gastric acidity and thereby reducing its bioavailability, particularly in the solid form. Beyond the classic tablet form, new formulations of LT4, such as a soft gel capsule and an oral solution, recently became available. The liquid formulation is supposed to overcome the food and beverages interference with absorption of LT4 tablets.

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Treatment of refractory and severe hypothyroidism with sublingual levothyroxine in liquid formulation

Cited by 14 publications

References 19 publications

Levothyroxine Therapy: Changes of TSH Levels by Switching Patients from Tablet to Liquid Formulation. A Systematic Review and Meta-Analysis

Levothyroxine Therapy: Changes of TSH Levels by Switching Patients from Tablet to Liquid Formulation. A Systematic Review and Meta-Analysis

The Human Microbiota in Endocrinology: Implications for Pathophysiology, Treatment, and Prognosis in Thyroid Diseases

Levothyroxine Therapy in Thyrodectomized Patients

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